BACKGROUND: Although previous studies have reported cases of coexistence of carotid-ophthalmic aneurysm (COA) and ophthalmic artery (OA) infundibulum, the hemodynamic characteristics of this complicated structure and its damaging effect on vision remain to be elucidated. The aim of this study was to analyze this specific artery structure using computational fluid dynamics (CFD) techniques. METHODS: We presented a patient diagnosed with COA, who had been suffering from blurred vision...

The complex anatomy of the carotid space within a small confined area is unique to the head and neck and allows for a vast array of pathology. This paper will review the anatomy of the carotid space from the skull base to the thorax, defining its borders at multiple levels, as well as its contents. The paper will also describe the myriad of mass lesions and vascular pathologies that may occur within the carotid space. The discussion will include anatomic considerations in differential diagnoses, imaging features, and lesion characteristics across multiple imaging modalities including CT, MRI, ultrasound, and conventional angiography...

BACKGROUND AND PURPOSE: There are very few published data on the patency of carotid stents implanted during thrombectomies for tandem lesions in the anterior circulation. We aimed to communicate our experience of stenting in the acute setting with systematic follow-up of stent patency and discuss predictors and clinical repercussions of delayed stent thrombosis. MATERIALS AND METHODS: We performed a retrospective study of stroke thrombectomies in a single center between January 2009 and April 2018...

Aims: SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1), expressed in endothelial cells (ECs) and platelets, exists in soluble or membrane forms. We previously showed that soluble SCUBE1 is a biomarker for platelet activation and also an active participant of thrombosis. However, whether the adhesive module of its EGF-like repeats is essential and the specific contribution of SCUBE1 synthesized in ECs or platelets to thrombosis in vivo remain unclear. Methods and Results: We generated new mutant (∆2) mice lacking the entire EGF-like repeats to evaluate the module's functional importance during thrombogenesis in vivo...

BACKGROUND: Mechanical thrombectomy is an effective management for acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be less than optimal. Herein, we presented a patient with right common carotid artery and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed...

A significant number of patients with minor or mild stroke symptoms on initial presentation subsequently develop neurological deterioration and poor clinical outcomes at hospital discharge. The presence of an underlying large vessel occlusion is a strong predictor of both clinical worsening and poor outcome. Although patients with a low baseline National Institutes of Health Stroke Scale (NIHSS) could have been included in some randomized controlled trials, the benefits of the mechanical thrombectomy for patients with a low NIHSS score are unknown...

Embolisms arising from the brachiocephalic artery are very rare, of which there are few reports. We treated a patient with cerebral embolism originating from the brachiocephalic artery. The patient was a 71-year-old man with high blood pressure, diabetes, and hyperlipidemia, who presented with a sudden disturbance of consciousness and left hemiparesis, and cerebral infarction of the right frontal lobe, right parietal lobe, bilateral occipital lobe, and bilateral hemisphere of cerebellum. There was no significant stenosis of a major artery or atrial fibrillation...

Limitations of existing thrombolytic therapies for acute ischemic stroke have motivated the development of catheter-based approaches that utilize no or low doses of thrombolytic drugs combined with a mechanical action to either dissolve or extract the thrombus. Sonothrombolysis accelerates thrombus dissolution via the application of ultrasound combined with microbubble contrast agents and low doses of thrombolytics to mechanically disrupt the fibrin mesh. In this work, we studied the efficacy of catheter-directed sonothrombolysis in a rat model of ischemic stroke...

An ideal stent to treat cerebral aneurysms should have an antithrombotic effect on the inner stent blood-facing side and a tissue organization effect on the outer aneurysmal side of the stent. The objective of this study is to evaluate the feasibility of a drug containing stent in the in vivo treatment of cerebral aneurysms. Argatroban, an antithrombotic drug, is encapsulated in biodegradable poly (d,l-lactide-co-glycolide) (PLGA) microspheres for the controlled release with an in vitro study conducted to evaluate the drug release and anticoagulation behavior of released drug...

A 54-year-old male with a history of left posterior parietal ischemic stroke, epilepsy, tobacco and marijuana smoking, and alcohol abuse, presented with acute left visual loss and diplopia. On examination, he had reduced left visual acuity and a left oculomotor nerve palsy. CT angiogram from aortic arch to circle of Willis identified extensive thrombus occluding the left common and internal carotid arteries, extending to the left ophthalmic artery. This case demonstrates acute visual loss from ophthalmic artery occlusion, and left oculomotor nerve palsy from occlusion of the inferolateral trunk of the internal carotid artery (cavernous sinus portion)...

A 45-year-old Chinese man presented with acute severe headache for 2 days. He was diagnosed as subarachnoid hemorrhage. Head CT and subsequent head digital subtraction angiography (DSA) showed left internal carotid artery (ICA) aneurysm in the supraclinoid segment. Stent-assisted coil embolization of aneurysm was performed. Three hours after the surgery, the patient was found to be drowsy and with paralysis of the right limb and slurred speech. Urgent head CT examination ruled out acute hemorrhage; however, DSA showed acute thrombosis in the left ICA between the branches of the ophthalmic artery and middle cerebral artery, which was probably from an acute in-stent thrombosis...

Sudden occlusion of an artery caused by a thrombus or emboli is the most frequent cause of acute brain ischemia (ABI). Carotid endarterectomy (CEA) represents the gold standard for preventing strokes of carotid origin. However, neuronal damage caused by ischemia and/or reperfusion may contribute to a poor clinical outcome after CEA. In response to shear stress caused by hypoxic-ischemic conditions in patients undergoing CEA, stimulation of the hypothalamic-pituitaryadrenal axis leads to biological responses known as hypermetabolic stress, characterized by hemodynamic, metabolic, inflammatory and immunological changes...

RATIONALE AND OBJECTIVES: Mechanical thrombectomy is common practice in proximal anterior vessel occlusion. However, it remains unclear whether peripheral artery occlusions should be treated as well. This retrospective study aimed to prove the effectiveness of endovascular recanalization treatment for the M2 segment by comparison of intracranial internal carotid artery (ICA), M1 segment, and M2 segment thrombectomy. MATERIALS AND METHODS: All patients who received endovascular treatment for distal ICA, M1, or M2 segment occlusions between January 2010 and July 2017 at our center were re-analyzed with respect to reperfusion success, interventional and clinical parameters...

Objective- After activation at the site of vascular injury, platelets differentiate into 2 subpopulations, exhibiting either proaggregatory or procoagulant phenotype. Although the functional role of proaggregatory platelets is well established, the physiological significance of procoagulant platelets, the dynamics of their formation, and spatial distribution in thrombus remain elusive. Approach and Results- Using transmission electron microscopy and fluorescence microscopy of arterial thrombi formed in vivo after ferric chloride-induced injury of carotid artery or mechanical injury of abdominal aorta in mice, we demonstrate that procoagulant platelets are located at the periphery of the formed thrombi...

Decreased adherence to daily ingestion of antiplatelet drugs is a critical issue, increasing mortality and morbidity in poststroke patients. As vaccination could be a promising approach to solving this, we designed an antiplatelet vaccine that inhibited S100A9 (S100 calcium-binding protein A9)/CD36 (cluster of differentiation 36) signaling in platelets, which was reported to be a key signal in arterial thrombosis, but not hemostasis. Immunization with this vaccine induced a sustainable increase in the anti-S100A9 antibody titer for >2 months and an additional booster immunization enhanced the antibody production further...